Rejected and denied claims are often confused but represent different challenges in the billing process. Rejected claims are those that haven’t entered the payer’s adjudication system due to formatting errors or missing information. These claims must be corrected and resubmitted by the billing team. In contrast, denied claims have been reviewed by the payer but rejected for payment, often due to issues like Assignment of Benefits (AOB) discrepancies or medical necessity concerns.

For healthcare organizations, addressing both types is critical. Rejection management focuses on identifying and fixing claim errors before submission, while denial management involves deeper analysis, appeals, and resolution strategies — particularly vital in specialized fields like Cardiology Billing Services.

To minimize revenue loss and improve cash flow, billers should perform root-cause analysis, correct systemic issues, and appeal denied claims promptly. At the same time, improving front-end processes is essential to reduce recurring denials and ensure long-term financial stability.